The Iowa Women's Health Study (IWHS) began in 1986 as a longitudinal cohort study to determine whether diet, body fat distribution, and other risk factors were related to cancer incidence among 41,836 post- menopausal women aged 55-69 years. Exposure and lifestyle information was collected in a baseline mailed survey in 1986, and five follow-up surveys in 1987, 1989, 1992, 1997 and 2004. Cancer incidence and mortality have been obtained by annual linkage with the Iowa Cancer Registry (a SEER cancer registry) and the National Death Index since 1986. The project has been extremely productive, with more than 260 research publications published to date. We propose, in this 5-year renewal, to continue to address important questions related to cancer in older women. The cohort is becoming especially informative with regard to less common cancers, and for lifestyle predictors of cancer occurrence and survival among the elderly. We also propose new linkages to sources of community-level data that will allow us to study how an individual's social and physical environment influences their cancer risk. These data sources include the Area Resource File (US Department of Health and Human Services), US Census Data, and data from the Rural Development Initiative Study based at Iowa State University. Our specific aims for the proposed funding period are to: 1) continue to follow the IWHS cohort, who are now 78-92 years old, through a total of 27 years (1986-2012), 2) expand our ongoing investigations of risk factors for incident cancers among women, 3) determine the factors associated with quality of life and mortality among female cancer survivors, and 4) determine the associations between community-level social and environmental characteristics and cancer outcomes and quality of life among elderly women. Continuation of funding for the IWHS is vital not only to completion of the research described in the specific aims, but is also key to supporting existing and several planned ancillary studies. The IWHS is also an active participant in several consortia of cohort studies. The combination of the extensive exposure and follow-up data already collected, linkage with community-level data that will be obtained at no cost, a productive research team, and the important research questions that are proposed make a 5-year continuation of the IWHS an extremely cost-effective means towards improving public health. PUBLIC HEALTH RELEVANCE: With the increasing number of Americans over the age of 65 years, prevention of cancer and its impact in later life is taking on greater importance. Research findings from the Iowa Women's Health Study will continue to add to our understanding of the potentially modifiable factors contributing to cancer prevention and survivorship, and will help public health and health care practitioners prioritize and better utilize health care resources.